When the Body Says No: The Cost of Hidden Stress (11 page)

Michelle grew up in a home where both parents were alcoholics. She now believes that her malignancy is related to early experiences that shaped how she has faced life. She has tried to cope in ways that, unconsciously, increased the stress load she had to carry for many
years—for example, by taking care of other people’s emotional needs rather than her own. “I’ve been confused all my life,” she says, “and I think my cancer had to do with confusion…. As much as I believe and understand my parents loved us the best way they knew how, it was the most confusing relationship and family environment because they were alcoholics, and still are. They’re unloving even though there is love.”

Research has suggested for decades that women are more prone to develop breast cancer if their childhoods were characterized by emotional disconnection from their parents or other disturbances in their upbringing; if they tend to repress emotions, particularly anger; if they lack nurturing social relationships in adulthood; and if they are the altruistic, compulsively caregiving types. In one study, psychologists interviewed patients admitted to hospital for breast biopsy, without knowing the pathology results. Researchers were able to predict the presence of cancer in up to 94 per cent of cases judging by such psychological factors alone.
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In a similar German study, forty women with breast cancer were matched with forty controls similar in age, general health history and lifestyle considerations. Again, on psychological grounds the researchers were 96 per cent successful in identifying who was and who was not diagnosed with breast cancer.
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As a man, Melvin Crew
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was at first embarrassed to learn of his diagnosis with breast cancer but decided that “there’s no sense just lying back and letting the disease consume you.” Now, several years after mastectomy, chemotherapy and radiation, he jokes about it. “At least if you fall down, you can’t go tits up because I only have one, you know.”

Fifty-one-year-old Crew was diagnosed in 1994 immediately after a highly stressful period in his life, including a brush with the law over a fishing infraction, public embarrassment, humiliation at work and undue pressure from his employer. He had been on a boat with ten other men and had caught three fish. When fisheries officers made a raid at his house, he gave them a statement.

“Two other chaps and myself took the brunt; the rest of the fellows denied it. It was hard on my family to have my name plastered across the papers—coast-guard employees charged with illegal fishing—and the whole works. And then, when I did go back on one of the other coast-guard ships, there was the heckling from the other crew members and the jokes that were made…. All the fellows at work said I should have denied it.”

This pressure was all the more stressful for Melvin, who describes himself as having always prided himself on his conscientiousness. “Some of my co-workers have said to me, you know, you take your job too serious. They think that I don’t relax enough.”

“Do you ever feel you’re doing the work that other people should have done?” I ask.

“Yes, you do more than your share. That’s probably just my nature—you know, you don’t want to be looked upon as a slackass.”

“If other people don’t do their share, one solution is to do it for them. The other is to get angry about it.”

“If you get angry, it’s like adding fuel to the fire. You have your conscientious workers, and you have your workers that just go with the flow. I did feel angry sometimes. Well, if you express it, you just bring on more problems with the workforce.”

The source of his hyper-conscientiousness became evident when I asked Melvin about his childhood.

“Was there much affection in your home?”

“Yes. My father was proud of my sister and me and our accomplishments in life. She’s a teacher. My father was an engineer, and I, of course, followed in his footsteps. Got my engineer’s licence, and my father was really proud of my being an aircraft engineer.”

“Warmth and affection have nothing to do with achievement: they are there regardless of achievement, just because the parents are emotionally connected with the child. But your answer had to do with accomplishment. I wonder why that is?”

“Well, my father was always proud of us.”

“What about your mom—what kind of affection did you get from your mom?”

“Not overly affectionate. We loved our parents, and I feel they certainly provided a good upbringing for us. A good home.”

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About 1 per cent of breast cancer patients are males. Their emotional histories parallel those of the women with the same disease. David Yeandle, a Toronto policeman, has had four separate cancers: in one of his kidneys, his breast and twice in his bladder. His upbringing was also characterized by a lack of warmth. Born in 1936, David was three when the Second World War broke out. His sister was born in 1940.

“My father was a warehouseman, and my mother worked at Cadbury’s chocolates…. I grew up during the war and actually didn’t see a lot of my parents. My mother was out during the day, and my sister and I used to take care of ourselves until she came home.

“You must mean that as a very small child, you used to take care of your sister.”

“Yes.”

David recalls his parents’ marriage as an unhappy one. “They weren’t a loving couple,” he says. “My dad did his thing, and my mother did hers. My dad, most evenings, would go out and shoot pool with his friends. I didn’t have a lot of respect for my mother. She always expected me to give more than I could. I guess I wasn’t a brilliant student. And my mother always saw herself much better than what she was. She was working class, the whole family was, but she always gave the impression to people that we were better than what we were. You had to perform to her standards.”

“When you were upset as a child, when you felt not understood, when you felt emotionally troubled, whom did you talk to about it?”

“Actually, you kept it within yourself. Dad was never there to talk to, and I certainly wouldn’t discuss it with my mother, because her favourite expression was ‘Oh, you’re being silly.’ I never showed anger with my parents. It was something you just didn’t do. I hold a lot of anger inside me.”

“Extreme suppression of anger” was the most commonly identified characteristic of breast cancer patients in a 1974 British study. The investigators looked at a consecutive series of 160 women admitted to hospital for breast biopsy. All subjects were given a detailed psychological interview and self-administered questionnaire. For corroboration, spouses or other family members were also interviewed, separately. Since the psychological testing took place before the biopsy, neither the women nor the interviewers could have prior knowledge of the ultimate
diagnosis. “Our principal finding was a significant association between the diagnosis of breast cancer and a behaviour pattern, persisting throughout adult life, of abnormal release of emotions. This abnormality was, in most cases, extreme suppression of anger and, in patients over 40, extreme suppression of other feelings.”
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A 1952 psychoanalytic evaluation of women with breast cancer had come to similar conclusions. These patients were said to demonstrate “an inability to discharge or deal appropriately with anger, agressiveness, or hostility (which, in turn, was masked by a facade of pleasantness).” The researchers felt that patients’ unresolved conflicts were “manifested through denial and unrealistic self-sacrificing behaviours.”
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The research conducted by Dr. Sandra Levy and her associates at the U.S. National Cancer Institute on the relationship between natural killer cell activity and emotional coping patterns in breast cancer concluded that
“suppression of anger and a passive, stoic response style seem to be associated with biological risk sequelae.”
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Repression of anger increases the risk for cancer for the very practical reason that it magnifies exposure to physiological stress. If people are not able to recognize intrusion, or are unable to assert themselves even when they do see a violation, they are likely to experience repeatedly the damage brought on by stress. Recall, from
chapter 3
, that stress is a physiological response to a perceived threat, physical or emotional, whether or not the individual is immediately aware of the perception.

“I obviously struggle with the first question that everyone I know who has had cancer asks: ‘What did I do to deserve this? Why me?’ Did I do something wrong? I went over and over everything. I’m not the one that was supposed to get breast cancer. I breast-fed my children to twenty-one months. I smoked a little, only when I was young. I didn’t drink too much. I exercised. I watched the fat in my diet. This wasn’t supposed to happen to me.” The speaker is Anna, a mother of three who was in her mid-forties when the suspicious lump was found eight years ago. Anna has one of the breast cancer genes.

Even in the small minority of cases where it is a major predisposing factor, heredity cannot by itself explain who gets breast cancer and who does not. DNA testing has shown that Anna inherited the breast cancer gene from her father. Other relatives with the same gene, older
than she is, have not developed breast cancer. Anna is convinced that stress was instrumental in the development of her cancer. Her first husband, a businessman, mistreated her emotionally throughout her marriage. By the time the relationship ended, she was also being physically abused. “If you ask me why I got cancer, I would tell you it’s because I allowed myself to be so destroyed in that marriage. I was this close to suicide more times than I …

“I didn’t have enough self-respect. Am I good enough yet, could you love me yet? I married my mom. He was exactly like my mother. I was never good enough. When I look back, I think, How could I have stayed in such a marriage? I’ve cried plenty over that at the therapist’s. How could I have done that to my soul, because that’s what I hurt. I hurt the essence of who I was. And I think I hurt my body too.

“Finally, I felt there was very little of me left in my world. I was taking eight prescription drugs a day for depression, anxiety, insomnia, aches and pains, bowel problems. It was either die, or get out. At that point, the self-preservation kicked in and I got out.”

Anna fits that pattern of “unrealistic self-sacrificing behaviours” noted in the 1952 psychoanalytic study of breast cancer patients. She is the only one among four siblings to take responsibility for her father, now in his eighties.

“He pulls on my heartstrings. I feel awful when he has a problem. I feel terrible when he phones up and says, ‘I’m so lonesome—I’ve got nowhere to go and nothing to do today.’ My sister, who I think is a bitch, says, ‘Hey, that’s his problem, he had a million choices and chances.’

“We went through a hysterical scene with him a year and a half ago when I asked him to go into respite care for one month. He’d been in the hospital, and I had been at the hospital all day every day, sitting there for hours and hours and hours. He came out and I felt like I was having a nervous breakdown from looking after him. I pulled the cancer card—the big card—and said, ‘Dad, look’—with the social workers and everyone—‘I’ve had cancer and I have to look after myself. I cannot look after you like this. Please (I’m crying by this point because I am the crier in the family), please, stay here for one month.’ He said, ‘No. Why should I? I don’t want to.’

“The social worker and the head of the program are saying to him, ‘Mr. W., no one wants to come into a seniors’ home. Could you do it
for your daughter? Look at your daughter—she’s crying and is really having a hard time. She needs time with her husband; she needs a break.’ ‘No, I won’t,’ he said. ‘Why should I?’

“When I had my double mastectomy, I asked my brother and sisters if they would look after Dad for a while. ‘I can’t have him over for dinner for a couple of months,’ I told them. ‘I need to recover.’ Within ten days he was here for dinner because no one else was looking after him. And nobody even notices.”

“What you’ve assumed toward your dad is a maternal role. Which is also why you’ve been taken for granted. Mother is taken for granted. Mother is like the world—she’s just supposed to be there and provide.”

“Absolutely. My brother does the same thing—I’m my brother’s mother as well. When he phones, my kids say, ‘Uncle Don must have a problem because he’s phoning again.’ He suffers from depression; he goes through relationships like you wouldn’t believe. He’s here day and night when there’s a problem. Then he won’t return my phone calls for months. He can’t be bothered.

“He came once the whole time I had chemotherapy. I sat down with him about a year and a half after my diagnosis and my chemo was over. That was my first experience with trying to say what I needed really clearly. I said, ‘Don, I need something from you. When I go to the cancer clinic for checkups, I need you to ask me how it came out. It’s really important to me. I need you to ask me what happened when I went.’ He leaned back and said, ‘I need something from you too,’ and launched into this long thing about his relationship with this girl that was breaking up. I just sat there and thought that he just didn’t get it at all. You’re right—at some point I realized, I’m mom.”

Anna felt repeatedly abandoned by her mother, who favoured her older sister. “I didn’t have a mom. My mom checked out,” she says, “and basically didn’t like me, so I really couldn’t afford to lose my dad, too. Kids are smart enough to understand they need a parent. And my father loved me the wrong way.” From adolescence on, Anna noticed her father casting undisguised sexual glances at her, particularly at her breasts.

“I picked up something from him, which I spent most of my life denying until I got into some counselling. He didn’t, as far as I know, do anything, but he wanted to. He looked … There was a sexual intensity that for an eleven- or twelve-year-old girl … I’m hypersensitive to anything
coming from men. Anything. But for a young woman to let herself believe that her father feels like that is really hard. I mean, Christ almighty, you make a million excuses for why it’s not real. My sister, though—there’s no way she would ever show up in a T-shirt when Dad was around.